Concussions in girls: Schools dealing with reaction to head injury

In years past when a football player would get dizzy after a play, it was understood he “got his bell rung” and chances are he would play the next snap.

He wouldn’t be given a concussion baseline test, let alone sit out until the dizziness subsided.

Now, concussion testing and training has become more accurate and readily available. The standard is quickly becoming that athletes are given the chance to heal without pressure to play through the pain.

While much of the focus on concussions continues in male dominated sports like football and hockey, there is an increasing awareness in girls sports like soccer, lacrosse and field hockey where collisions and hits are also prevalent.

Educating parents and student-athletes about concussions is becoming a top priority in high school athletic departments.

“People of my generation — the 40- and 50-year-olds — we’ve all been hit in the head, they’ve been ‘dinged’ or ‘got our bell rung,’” Pottsgrove High School Athletic Director Gary DeRenzo said. “But I think now, because they are able to pinpoint the research, they can say there is some damage that is done.”

DeRenzo said he now hosts meetings for parents and athletes before the beginning of each season to introduce guidelines and regulations on how concussions and head injuries will be handled.

Before each season, student-athletes take a computerized ImPACT Test that tracks brain functions before any reported concussions. These tests, according to DeRenzo, are made up of pictures, patterns and phrases that create a map of the athlete’s brain function.

All student-athletes at Pottsgrove High School take the test except girls tennis players, boy’s tennis players and cross country runners, DeRenzo said.

Coaches are also required to go through pre-season testing.

“If the coach doesn’t do that, they don’t coach,” DeRenzo said.

But the testing does not stop when the season starts.

“If one of our student athletes has some kind of collision, and we feel there is a concussion or a slight concussion, we bring them in and they take the test again,” DeRenzo said.

DeRenzo said that the team doctor will read the results of the test and determine if there is a concussion.

Not only does the testing not stop once the season starts, neither does the education.

Several years ago, while the athletic director in Pottstown, DeRenzo had to explain to Tammy Moore why girls on the middle school lacrosse team do not wear helmets like the players on the boys team.

The explanation — because the rules are different and girls lacrosse players are not allowed as much checking or high sticking as the boys — became necessary after Moore’s daughter Jaime had her orbital bone fractured during a practice.

“She missed a ball thrown at her and it hit her right in the face mask and it crushed her orbital bone,” Moore said.

Now 21 and a nursing student at Montgomery County Community College, Jaime still suffers from migraines.

It is not only the student athletes affected by such injuries. Worried parents must often navigate the medical after-affects of the injury which, in Jaime’s case, were complicated.

“Her orbital bone was crushed so we were going back and forth to Reading every other day. It was not a fun time, and she was in a lot of pain,” said Moore. “In the beginning, we had to wake her up every few hours and she was vomiting all the time and she was not healing the way the doctors kept telling us she should be.”

Jaime’s injury was difficult to diagnose, Moore said, and several therapies were tried.

Ultimately Jaime’s doctor, David Goldberg of Eye Consultants of Pennsylvania, recommended surgery, which put a metal plate where Jaime’s orbital bone had been.

Afterward Jaime was prohibited from returning to the field “and she still flinches whenever anything comes at her,” Moore said of her daughter.

“I guess what happened to Jaime was a fluke, but there’s a part of me that wishes the girls would wear helmets,” she said.

Fortunately, not all injuries are so severe, and they are increasingly taken more seriously than in decades past.

Despite the increased athleticism, competitiveness and popularity of soccer and other sports for young girls, DeRenzo said that top players do not underplay their head injuries.

“(Female athletes) know that the game is not more important than their health,” he said.

There is an athletic trainer at all the games and the district asks parents to help monitor their athlete as well. If the doctor sees any reason to re-test the athlete, they will come in and take the ImPACT Test again.

DeRenzo said it is never the coach’s responsibility to determine if a player has a concussion, only to keep them from playing for the pre-determined amount of time.

Joe Margusity, the president of the Vincent United Soccer Club, has been coaching girls soccer teams for more than 20 years. He agrees with the changes being made in protocol because it means the health of the athletes comes first.

Margusity, who coaches soccer players between the ages of 8 and 19, said that youth sports has become more competitive than in the past and players are given more opportunities to excel with year-long training.

But the intensified training can increase the possibility of head injuries.

“We have to set realistic parameters,” he said about the way athletes compete. “You are going to have collisions.

Margusity said with the extended training and growing collegiate programs, he sees girls becoming more aggressive and more willing to head the ball in soccer.

“I see one or two players who are good and willing to be physical,” Margusity said. He said that around age 15, some of his girls’ soccer players are ready to head the ball.

DeRenzo has also seen a change in female athletes.

“Girls sports have continued to evolve,” DeRenzo said. “What you are seeing now are high quality players that are mirroring what the boys did. They are bigger, faster and stronger and they are specializing in sports.”

DeRenzo estimates that girls have tripled their amount of competitive playing time in soccer over the last 15 years. The main reason is that soccer leagues now operate year-round, giving girls more opportunity to compete and more necessity to train.

The elevated competition has also led to some pushback from parents about the attention on head injury recovery. With more competition for college scholarships, parents are sometimes dubious as to why their daughters should be sitting out while other girls are gaining playing time.

“It is the parents who are needy, not the kids,” Margusity said. “I have to remind them it is a game sometimes.”

DeRenzo said, however, that he got little parent pushback after his pre-season meeting. He said that change can be difficult, but a student’s health trumps playing time.

A similar approach is taken at The Hill School, said athletic director Seth Eilberg.

“We take concussions very seriously,” said Eilberg who added that, like Pottsgrove, The Hill creates a concussion “baseline” for each student athlete at the beginning of the season and has a protocol for them an injured athlete can return to play.

The Hill also stresses training as a way to avoid injury.

“We had a number of ankle injuries on the basketball team a few years ago, so we developed a number of exercises and had the students do them all year long and the result was many fewer strains,” Eilberg said. “Of course, that can be more difficult in trying to avoid concussions.”

“We have an outstanding support staff and two full-time trainers and any student who receives a head injury has to be cleared by our health center before returning to the field,” he said, noting that the presence of nurse practitioner Kathleen Van Buren, who is working on a Ph.D. thesis about concussions, provides an additional layer of expertise.

According to Margusity, a player has to have seven symptom-free days before being allowed to practice again.

Researchers, who studied athletes from 100 high schools around the United States from 2005-2007, found that while male and female athletes returned to play at varying times after suffering a concussion, girls were found to return to play more quickly.

“The greatest percentage of males returned to play between seven and nine days after concussion, whereas the greatest percentage of females returned between three and six days after concussion,” the study said.

With new regulations and standards in place, parents and players do not determine when it is appropriate for play to resume after an injury.

The new training allows the coaches to coach and trained professionals to diagnose a player with a concussion, DeRenzo said.

“The final call for us is our athletic training staff. Coaches and parents don’t tell us when an athlete should be playing,” DeRenzo said.

He emphasized that attitudes about concussions have changed in the last decade. The health impact of the injury is better understood. Schools are working to insure not only that athletes rest from the sport but that as students, they rest their brains, as well.

DeRenzo said that Pottsgrove now uses Brain Steps, a school re-entry consultation program to help determine when student-athletes can resume school work.

The reality is quite simple, DeRenzo said: “A blow to the head is a blow to the head.”